ABSTRACT
Objective To discuss the diagnosis and treatment of the postoperative acquired primary hyperfibrinolysis secondary to bipolar plasmakinetic transurethral resection of the prostate ( BP-TURP ) . Methods A case with benign prostatic hyperplasia was retrospectively reviewed, who was an 88-year-old patient admitted on 14th October, 2013 because of repeated urinary retention for 10 years, and catheter indwelling for 20 days.Blood pressure was 101/59 mmHg on admission (1 mmHg=0.133 kPa).Digital rectal examination showedⅡ°prostate, smooth surface, rubbery and no nodules.Routine blood showed the leucocyte 4.6 ×109/L, neutrophils 0.62, hemoglobin 108 g/L, red blood cells 3.30 ×1012/L, platelet 90 ×109/L.Preoperative coagulation function showed prothrombin time (PT) 12.8 s (10-14), activated clotting time live enzymes (APTT) 34.8 s (21 -37), fibrinogen (FiB-C) 2.38 g/L (2 -4), D-dimer 0.50 mg/L (0-0.55), fibrin degradation products (FDP) 2.0 mg/L ( <5.0).Abdominal ultrasound showed hyperplasia of prostate ( 52 mm ×46 mm ×37 mm ) , protruding into the bladder about 20 mm. Abdominal CT scanning showed bladder diverticulum and stones, hyperplasia of prostate and calcification. The operation time of BP-TURP was 90 min with no significant intraoperative bleeding, and continuous bladder irrigation drainage was clear.Results Four hours after the operation, continuous bladder irrigation drainage became bright red.Seven hours after operation, blood pressure was 83/56 mmHg, and blood routine showed white blood cells 8.1 ×109/L, neutrophils 0.92, red blood cells 2.93 ×1012/L, hemoglobin 95 g/L, platelet 67 ×109/L.Transfusion of 4.5 U red blood cell suspension was administered.The prostatic fossa hemorrhage was suspected and bleeding was not alleviated after adjusting the catheter.Prostatic fossa electro-coagulation hemostasis was performed and bladder neck obvious oozing of blood was detected intraoperatively, and no venous sinus bleeding or obvious blood clots were detected.Four hours after the secondary surgery, continuous bladder irrigation drainage became pink again, and the conservative treatment had no effect.Blood coagulation function showed PT 16.9 s, APTT 43.5 s, FiB-C 0.34 g/L, D-dimer 1.70 mg/L, FDP 57.4 mg/L.The patient was diagnosed as postoperative acquired primary hyperfibrinolysis, and repeat plasma, red blood cell suspension, and tranexamic acid transfusion was administered.Continuous bladder irrigation drainage gradually became clear.Blood coagulation function index gradually returned to normal.Routine urine test showed red blood cells ( microscopy ) 4 -5/HPF. Conclusions After BP-TURP, acquired primary hyperfibrinolysis may occur.The outcome is good after timely diagnosis and effective treatment.